The Partin tables use clinical features of prostate cancer — Gleason score, serum PSA and clinical stage – to predict whether the tumor will be confined to the prostate. The tables are based on the accumulated experience of urologists performing radical prostatectomy at the James Buchanan Brady Urological Institute. For decades, urologists around the world have relied on the tables for counseling patients preoperatively and for surgical planning.
Since PSA screening was introduced in the early 1990s, the extent of disease for men with prostate cancer has slowly changed over time. Also, subtle changes to the Gleason scoring system have made the system more accurate but were not considered in previous editions of the Partin tables. Earlier this year, the tables were updated using the experience of surgeons at the Brady Institute performing radical prostatectomy from 2006 to 2011.
Interestingly, the change in extent of disease seen since PSA testing became commonplace has stabilized, something not previously reported.
The analysis demonstrated that most men with Gleason 3+3 disease and many with Gleason 3+4 disease do not require pelvic lymph node removal during radical prostatectomy. Also, traditionally men with Gleason 8, 9 or 10 disease have been considered high risk, though in our analysis Gleason 8 disease had similar tumor extent to Gleason 4+3 rather than Gleason 9–10. Clinicians should use the updated tables when counseling patients on the extent of their disease and to help determine who would likely benefit from removing the lymph nodes during radical prostatectomy.
An Updated Prostate Cancer Staging Nomogram (Partin Tables) Based on Cases from 2006 to 2011
John B. Eifler, Zhaoyang Feng, Brian M. Lin, Michael T. Partin, Elizabeth B. Humphreys, Misop Han, Jonathan I. Epstein, Patrick C. Walsh, Bruce J. Trock and Alan W. Partin
The James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Md., USA
The Partin tables use commonly available preoperative data — serum PSA level, clinical stage and biopsy Gleason score — to predict pathological stage at radical prostatectomy. The original Partin tables used preoperative data from men who were treated between 1982 and 1991, so most were diagnosed in the pre-PSA era  . Updates to the Partin tables reflected the changing nature of prostate cancer.
Accepted for publication March 23, 2012.
What's known on the subject? And what does the study add? Pathological stage after radical prostatectomy can be accurately predicted by serum PSA level, clinical stage and biopsy Gleason sum, or the Partin tables. Since the previous publication of the Partin tables, an updated Gleason scoring system has been established and incremental changes have occurred in the clinical characteristics of patients diagnosed with prostate cancer. The current analysis updates the Partin nomogram in a contemporary cohort of patients.
To update the 2007 Partin tables in a contemporary patient population
Patients and Methods
The study population consisted of 5,629 consecutive men who underwent radical prostatectomy and staging lymphadenectomy at The Johns Hopkins Hospital between January 1, 2006 and July 30, 2011 and met inclusion criteria.
- Polychotomous logistic regression analysis was used to predict the probability of each pathologic stage category: organ-confined (OC) disease, extraprostatic extension (EPE), seminal vesicle involvement (SV + ), or lymph node involvement (LN + ) based on preoperative criteria.
- Preoperative variables included biopsy Gleason score (6, 3+4, 4+3, 8 and 9–10), serum PSA (0–2.5, 2.6–4, 4.1–6, 6.1–10 and greater than 10 ng/ml), and clinical stage (T1c, T2c and T2b/T2c).
- Bootstrap resampling with 1,000 replications was performed to estimate 95 percent confidence intervals for predicted probabilities of each pathologic state.
The median PSA was 4.9 ng/ml; 63 percent had Gleason 6 disease, and 78 percent of men had T1c disease.
73 percent of patients had OC disease, 23 percent had EPE, 3 percent had SV+ but not LN+, and 1 percent had LN+ disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic state.
The risk of LN+ disease was significantly higher for tumors with biopsy Gleason 9–10 than Gleason 8 (OR 3.2; 95% CI 1.3–7.6).
The c-indexes for EPE vs. OC, SV+ vs. OC and LN+ vs. OC were 0.702, 0.853 and 0.917, respectively.
Men with biopsy Gleason 4+3 and Gleason 8 had similar predicted probabilities for all pathologic stages.
Most men presenting with Gleason 6 disease or Gleason 3+4 disease have < 2 percent risk of harboring LN+ disease and may have lymphadenectomy omitted at radical prostatectomy.
The distribution of pathologic stages did not change at our institution between 2000 and 2005 and 2006 and 2011.
The updated Partin nomogram takes into account the updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer.
|TABLE 1. Characteristics of men undergoing radical prostatectomy at The Johns Hopkins Hospital, 2006–2011 compared with the 2000–2005 cohort used in the 2007 publication|
|Characteristic||Current Cohort||2000–2005 Cohort|
|Mean (SD)||58.5 (6.66)||57.4 (6.36)|
|Median (range)||59 (34–77)||58 (34–77)|
|Ethnicity, n (%):|
|White||4,579 (81)*||5,081 (89)|
|African American||665 (12)||372 (7)|
|Hispanic||113 (2)||56 (1)|
|Asian||59 (1)||58 (1)|
|Other||213 (4)||158 (3)|
|PSA (ng/ml), n (%):|
|0–2.5||518 (9)||452 (8)|
|2.6–4||1,161 (21)||946 (17)|
|4.1–6||2,266 (40)||1,994 (35)|
|6.1–10||1,219 (22)||1,671 (29)|
|>10||465 (8)||667 (12)|
|Mean (SD)||5.8 (4.35)||6.5 (4.56)|
|Median (range)||4.9 (0.2 – 67.0)||5.5 (0.1 – 64.8)|
|Biopsy Gleason score, n (%):|
|6||3,538 (63)||4,402 (77)|
|3+4||1,268 (22)||816 (14)|
|4+3||495 (9)||348 (6)|
|8||218 (4)||64 (3) †|
|Clinical stage, n (%):|
|T1c||4,380 (78)||4,419 (77)|
|T2a||897 (16)||998 (17)|
|T2b||307 (5)||279 (5)|
|T2c||45 (1)||34 (1)|
|Prostatectomy Gleason score, n (%):|
|6||2,834 (50)||3,693 (64)|
|3+4||1,689 (30)||1,304 (23)|
|4+3||691 (12)||425 (7)|
|8||204 (4)||308 (5) †|
|Pathological stage, n (%):|
|Organ confined (OC)||4,082 (73)||4,204 (73)|
|Extraprostatic extension (EPE)||1,277 (23)||1,276 (22)|
|Seminal vesicle involvement (SV+)||191 (3)||180 (3)|
|Lymph node involvement (LN+)||79 (1)||70 (1)|
*Number of patients (percentage).
† Gleason score includes Gleason 8–10.